Lai Weisi, Ding Yiling, Wen Lieming
Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, China.
Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China.
Pulm Circ. 2021 Feb 2;11(1):2045894020966876. doi: 10.1177/2045894020966876. eCollection 2021 Jan-Mar.
Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.
近期研究表明，对于中度肺动脉高压女性，妊娠可能并非绝对禁忌。我们旨在评估在我们临床科室经超声心动图诊断为肺动脉高压的孕妇的长期结局。本回顾性队列研究纳入了2004年至2016年间因终止妊娠或分娩入住我们科室、经超声心动图诊断肺动脉收缩压>30 mmHg的肺动脉高压孕妇。报告了人口统计学特征、临床病史、围产期结局及出院后的随访结局。主要结局是孕妇出院后的生存情况。本队列研究共纳入88例肺动脉高压孕妇。根据入院时的肺动脉收缩压将这些女性分为重度和中度肺动脉高压组。重度肺动脉高压女性在围产期心脏功能恶化的可能性显著更高，新生儿并发症发生率也更高（p<0.05）。在中位随访26个月期间，重度肺动脉高压女性的死亡率显著更高（p<0.05）。然而，在随访期内，中度肺动脉高压女性的累积生存率>90%。多因素Cox回归分析显示，妊娠前心脏功能差、产前检查不规律和高尿酸血症是肺动脉高压女性出院后独立的死亡风险因素。总之，在本队列中，经超声心动图诊断为中度肺动脉高压的孕妇的长期生存情况被认为是可以接受的。我们的研究结果表明，对于中度肺动脉高压女性，妊娠可能并非绝对禁忌。
